| NPI | 1528550746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6000029-15) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH RES.003956) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2022-08-15 |